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Capital Medical Center in Olympia is being sued by the state for allegedly repeatedly violating state law by withholding charity care from thousands of low-income patients.

The lawsuit alleges that management at Capital Medical Center, a for-profit hospital, created a culture that elevated aggressive collection over access to charity care. Capital trained staff to pressure patients to pay for their treatment upfront without screening patients for charity care eligibility or providing notice of the availability of charity care, Attorney General Bob Ferguson said Friday.

Capital’s focus on aggressive collection came from its management, according to the lawsuit. Capital’s former CEO, Jim Geist, called collection and registration staff members the emergency department’s “money makers.” He said in a 2012 meeting that the hospital needed to “get something out of” every patient and told staff to not let uninsured patients “leave without paying anything.”

Because of these coercive practices, thousands of charity care-qualified patients were forced to pay for their treatment upfront, incur medical debt, or defer important medical care, according to the lawsuit.

Only require patients to provide one income-related document to prove charity care eligibility.

In the lawsuit, the state alleges that Capital violated all of these requirements by training its staff to aggressively demand payment from patients without screening them for charity care eligibility or informing them of their charity care rights. Capital also required that patients produce multiple forms of income documentation to apply for charity care.

In a letter to patients who did apply, the hospital required patients to provide up to eight documents proving income, including written documentation from income sources, a current credit report, and three pay stubs.

Capital trained its staff to present only upfront payment, payment plans, and medical credit cards as payment options and only to provide information about charity care to patients who explicitly requested it.

Capital’s Patient Access Department “cleared” uninsured patients before scheduling them for surgery. During clearance, staff members informed patients of the cost of their treatment, assessed their ability to pay this amount, and attempted to reach a negotiated payment arrangement.

During pre-treatment collection calls, Capital threatened to cancel medical appointments and surgeries if patients didn’t agree to make upfront payments. They didn’t screen patients for charity care eligibility during this process.

Capital provided cash bonuses and other incentives to staff who met collection targets. In an email to a team of emergency room registrars, Capital’s patient access director emphasized collecting payment from “every patient, every time.”

Capital required staff members to attempt to collect a deposit from every patient in the emergency room, even those in hospital beds and gowns, regardless of their ability to pay. Capital continued to demand $200 deposits from uninsured patients even after it screened them for charity care.

Capital’s aggressive collection practices reduced the amount of charity care it provided, Ferguson said. Between 2012 and 2015, Capital consistently provided less charity care than the regional average, often less than 1 percent of its revenue.

For instance, in 2014, hospitals in Southwest Washington provided an average of about 6 percent of their revenue in charity care. Capital provided just .37 percent of its adjusted revenue in charity care that year, leaving Capital with the lowest charity care rate in both the region and in Washington state.

The state’s lawsuit seeks to ensure that Capital Medical Center provides patients with notice of their charity care rights before requesting payment, properly screens them for charity care eligibility, and ceases its aggressive collection practices. It also seeks restitution for low-income patients harmed by the hospital’s practices, in addition to penalties.

Note: This is a seattlepi.com reader blog. It is not written or edited by the P-I. The authors are solely responsible for content. E-mail us at newmedia@seattlepi.com if you consider a post inappropriate.